Southeastern Ontario H H H O H H H H tPA sites H H Regional Stroke Centre H H H District Stroke Centre H using telestroke H H H H Community hospital H using telestroke In- hospital stroke protocol activations 13 at KGH; 5 at QHC KGH DTN time 47 mins; QHC 67 mins in FY 13-14 NB - value of EMS pre-notification!! Median DTN time Dec 2010-Dec 2014 = 63 mins Ave Door to CT time 14.3 mins NB – EMS accompany patient to CT - saving the brain Public Release June 18th 2015 Ontario Stroke Evaluation FY 13-14 ◦ CIHI administrative data ◦ CIHI 340 – stroke data N=136 N = 66 N = 69 N = 74 N = 21 NEW! Stroke Units opened in Brockville Dec 2013 and Belleville June 2014; Napanee transfers to KGH unit 2013 QHC- KGH TOH CCH PRHC TOTAL B Public Awareness: 0- 30 mins 7 7 14 ASP calls 31- 60 mins 46 44 3 1 94 symptom onset to 61- 90 mins 40 52 12 1 105 arrival at a stroke 91- 120 mins 18 35 15 1 69 centre 121-210 mins 16 42 16 1 75 Greater than 3.5 1 1 1 hrs 3 2014 Total 128 181 47 3 1 360 QHC- KGH TOH CCH PRHC TOTAL B 0- 30 mins 5 3 8 31- 60 mins 30 43 8 81 61- 90 mins 34 41 24 1 104 91- 120 mins 25 44 9 79 121-210 mins 28 57 16 104 Greater than 3.5 hrs 3 7 10 Total 125 195 57 6 3 386 66% 67% 67% 60% 62% 50% 55% 55% 46% 56% 51% 51% 62% 41% 25% Frontenac Hastings-Quinte Lanark Leeds-Grenville Lennox & Prince Edward Addington County 2012 2013 2014 ACUTE STROKE PROTOCOL PATIENTS (n=360) RESPONDING AMBULANCE SERVICE 2013 Lennox & Addington ASP stroke calls 6% by location Leeds Grenville Frontenac 18% 25% N=360 Hastings-Quinte 36% Lanark County 15% ACUTE STROKE PROTOCOL PATIENTS (n=386) RESPONDING AMBULANCE SERVICE Lennox & Addington 7% Leeds-Grenville 19% Frontenac 2014 22% Lanark County ASP stroke calls by Hastings-Quinte 19% location 33% N=386 Location of ASP Stroke Calls within each County by Calendar Year Frontenac Hastings-Quinte Lanark Leeds & Grenville Lennox & Addington Prince Edward 120 HQ N = 113 100 Fr N = 82 80 LG N =80 60 Lanark N=66 40 L&A N = 27 20 PE N = 15 0 2007 2008 2009 2010 2011 2012 2013 2014 2009 2010 2011 2012 2013 2014 Stroke Centre 74 74 129 161 176 165 closest (33%) (34%) (44%) (46%) (49%) (43%) hospital Bypassed 112 106 115 133 146 135 (50%) (48%) (39%) (38%) (40.5%) (35%) Transferred 44 39 49 56 38 86 (17%) (18%) (17%) (16%) (10.5%) (22%) TOTAL 223 219 293 350 360 386 Reasons for the 86 transfers in 2014: 47 brought by private car (compared to 18 in 2013) Home location for these 47 patients: 3 unknown how arrived in ED Almonte 4 Napanee 5 15 in-hospital strokes (4 in 2013) Bancroft 5 Perth 9 4 Brought to ED by ambulance after TIA recurred in ED Brockville 4 Picton 3 17 others brought to ED (4 GSC<10; 2 seizures; 2 confusion only; Carleton Place 1 Smiths Falls 7 3 UTD onset; 2 outside time window; 1 CVA in ED; 1 unstable; Kemptville 4 Trenton 4 1 STEMI; 1 symptoms unclear) Kingston 1 www.strokenetworkseo.ca Responding Ambulance Service (n = 852) Lennox & Addington EMS Leeds Grenville EMS 57 Frontenac Paramedic 2013 166 7% Service 19% 219 26% ALL stroke calls by location N=852 Lanark County Ambulance 118 14% Hastings-Quinte EMS 292 34% Responding Ambulance Service (n = 962) Lennox & Addington EMS Leeds-Grenville 71 Frontenac Paramedic Paramedic Service 7% Service 190 236 2014 20% 25% ALL stroke calls by location Lanark County Paramedic N=962 Service 159 Hastings-Quinte 16% Paramedic Service 306 32% Location of ALL Stroke Calls within each County by Calendar Year Frontenac Hastings-Quinte Lanark Leeds & Grenville Lennox & Addington Prince Edward 260 HQ N = 254 240 Fr N = 232 220 200 LG N = 207 180 160 140 Lanark N=136 120 100 80 L&A N = 73 60 PE N = 49 40 20 2007 2008 2009 2010 2011 2012 2013 2014.